Medication perils

Whether we're reminded by the odd ache or pain, a few new wrinkles, or stronger eyeglasses, we're only too aware that our bodies don't work quite as efficiently as we continue to rack up birthdays.

This shift also translates into how well the body absorbs or gets rid of the medications we may take for a host of physical or mental health conditions.

"Part of the process of aging is the natural slowing down of certain elimination pathways," says Gretchen Stern, a clinical pharmacist at Harvard-affiliated Brigham and Women's Hospital. "That's why older adults may do better on lower doses of some medications and may be safer avoiding others entirely."

Risk factors

Adults 65 and older use more over-the-counter drugs than any other age group in the United States. Half use such a product daily or weekly, while one-quarter use a combination of 10 or more prescription and over-the-counter medications.

Older adults are also seven times more likely than younger people to experience an adverse drug event that lands them in the hospital, Stern says, though 80% of such complications are preventable.

Why are seniors more vulnerable to certain drugs as years pass?

They have more health problems. Nearly 95% of people 65 and older have at least one chronic condition, such as arthritis, heart disease, or diabetes, and 80% have two or more.

Their muscle mass declines. With less muscle — and often a shift in fat distribution as well — medications can't travel toward or away from certain body areas as they would in a younger person.

They become more frail. Frailty isn't always easy to measure, but it typically includes a mix of muscle weakness, slowness while walking, unintentional weight loss, and exhaustion.

They're more sensitive to drug side effects. Medications that are more easily tolerated by a younger person may sideline an older one with effects such as insomnia, dizziness, drowsiness, headache, nausea, diarrhea, or constipation.

Drugs to watch

What over-the-counter medications should you reconsider if you're 65 or older? Stern points to four common examples and offers advice about better options. Make sure to discuss any potential medication changes with your doctor beforehand.

Aspirin. This over-the-counter staple "thins" the blood — that is, makes it less likely to clot. That might help lower the risk of heart attack or stroke, which is why low-dose aspirin is often prescribed for people with cardiovascular disease. But the risk of major bleeding problems increases with age.

Instead: If you use aspirin as an occasional pain reliever and your liver function is normal, consider switching to acetaminophen (Tylenol). If you're taking aspirin to prevent cardiovascular complications — but you don't have diagnosed heart disease or you take another blood-thinning medication as well — talk to your doctor about whether it's safe to continue.

Nonsteroidal anti-inflammatory drugs (NSAIDs). Widely used to treat arthritis, which affects more than half of American adults 75 and older, these pain relievers (including ibuprofen [Advil] and naproxen [Aleve]) also pose a risk of bleeding, especially in the gastrointestinal tract. In addition, NSAIDs can contribute to kidney problems or to leg swelling in people with heart problems.

Instead: If your liver function is normal, try acetaminophen (Tylenol). Topical NSAID creams and ointments can relieve pain from arthritis-affected joints without being absorbed throughout the body.

Proton-pump inhibitors (PPIs). Often used long-term to treat acid reflux or gastroesophageal reflux disease (GERD), nonprescription PPIs include lansoprazole (Prevacid), esomeprazole (Nexium), and omeprazole (Prilosec). But since they alter the stomach's acidity, they can fuel bacterial infections that are often worse in older adults, such as pneumonia. PPIs may also decrease the amount of vitamin B₁₂, vitamin D, and calcium absorbed from foods.

Instead: Antacids like calcium carbonate (Tums) don't affect stomach acid production as much and can be taken as needed. Ask your doctor how you can modify your diet to alleviate acid reflux or if you can decrease your PPI dose.

Diphenhydramine (Benadryl). This allergy reliever is also a popular sleep aid. But this and other so-called first-generation antihistamines (including brompheniramine [Dimetapp] and chlorphenamine [Chlor-Trimeton]) can cause confusion, delirium, dry mouth and eyes, constipation, blurred vision, and falls.

Instead: For allergy symptoms, try a newer-generation antihistamine such as cetirizine (Zyrtec), loratadine (Claritin), or fexofenadine (Allegra). For insomnia, a melatonin supplement is a safer choice, Stern says.

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